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Dialysis patients help themselves to treatment

Back row left to right – Margie Caingles (associate charge nurse manager), Lally Naidu (registered nurse), Dr Peter Sizeland (clinical director), Christie Thomas (registered nurse) Mark Hodge (clinical nurse specialist chronic kidney disease), Sue Newton (speciality clinical nurse – home training), Nicky Hagan (charge nurse manager), and Suzanne English (registered nurse). Patients in front are, left, Jake Wharewhiti and, right, Shane Waraki.

Back row left to right – Margie Caingles (associate charge nurse manager), Lally Naidu (registered nurse), Dr Peter Sizeland (clinical director), Christie Thomas (registered nurse) Mark Hodge (clinical nurse specialist chronic kidney disease), Sue Newton (speciality clinical nurse – home training), Nicky Hagan (charge nurse manager), and Suzanne English (registered nurse). Patients in front are, left, Jake Wharewhiti and, right, Shane Waraki.

Shane Waraki and Jake Wharewhiti are in no doubt learning to do their own care at Waikato District Health Board’s Regional Renal Centre in Hamilton has given them a quality of life they could only dream of months ago.

As part of the Assisted Care Programme, which was introduced in August 2013, they underwent a training programme which then allows them to reach a target of at least 80 per cent independence with their haemodialysis treatment.

This may include tasks such as setting the machines up, needling themselves and putting themselves on and off the dialysis machine.

Previously these patients would have been 100 per cent dependent on the nursing staff for all cares.

They still require some nursing care for the other 20 per cent of the time. “I was eager to learn, it’s in my nature. I do the needling myself now even though I was initially apprehensive,” said Shane. It gives him a sense of well-being and achievement. “I feel more in control of my own health. My family, especially my wife, think it is marvellous. She is my biggest supporter and she likes it.”

Shane has been attending the Regional Renal Centre for nearly three years – the last 14 months for haemodialysis and 18 months before that on continuous ambulatory peritoneal dialysis.

Being able to help himself means he has more time with the grandchildren, can attend their school sports and help them out with their academic work.

I’m teaching them now, saying to them that what happened to me, I don’t want that to happen to them

His eldest grandchild recently asked him what it was like so, after speaking to the dialysis staff, Shane brought two of his grandchildren to the centre to see for themselves. “I’m teaching them now, saying to them that what happened to me, I don’t want that to happen to them.” Jake is originally from Christchurch and transferred to Hamilton after the 2011 earthquake.

He is about to head home having learned how to look after most of his dialysis cares through the Assisted Care Programme. “You can set your own goals as part of the programme, come in early and set it all up.

I now have much more control about when my dialysis starts on allocated treatment days.” Jake has made life-long friends in the centre; it is a very social environment, he says.

Plus he had his moment in the limelight at the centre’s opening in November 2012 when he was part of a boy band which sang for Health Minister Tony Ryall.

Charge nurse manager Nicky Hagan said before the programme started all patients in the in-centre dialysis unit were fully dependent.

Self-treatment means people can have a more independent, better quality life by fitting in the long treatments – up to six hours three times a week – into their routine, rather than having to attend set appointment times.

It also frees up space in specialist units for people unable to manage at home or in the community. ”We now have a group of patients who have some control and independence over their treatment. “The ultimate aim of this programme is to see more patients go through to home training and eventually go home to be fully independent with their treatment although this is not realistic for all patients in this programme,” she said.

The Waikato renal service prides itself on the number of patients it has doing home based dialysis with around 65 per cent achieving this, which is above the national average.

There are a number of patients unable to do dialysis at home for all kinds of reasons but can look after themselves with the security and support of the dialysis centre. “If we can get them doing a component of their own care to start with it might encourage them to go home. “It makes people more independent.”

The Regional Renal Centre has a capacity of 120 patients with the Assisted Care programme taking potentially 40 of those patients.

Six of the dialysis stations in the $7.6 million centre were not commissioned after opening and it is these being used at no extra cost.

Nicky saw an opportunity with using older machines from patients’ homes where newer machines had been put in. Waikato DHB has about 90 machines in people’s homes throughout the Midland region.

The programme started with three patients but one of them was too ill and could not manage. The others trained over three weeks.

Research shows that patients who take on more responsibility for their own care have better health outcomes including quality of life.

Nicky acknowledges some patients find doing their own home dialysis daunting but gain confidence by learning while in the centre.

I am always still amazed at our patients who can line and prime the dialysis machine on their own

Some people have a needle phobia and may not be able to have treatment at home. “I am always still amazed at our patients who can line and prime the dialysis machine on their own. Their families help particularly where there are disability issues.” Missing the life-sustaining treatment is not an option. Nurse Suzanne English, who has been with the programme since the beginning and learned how to train patients from the home training dialysis nurses, says she has enjoyed it. “We see the same patients, they become our patients, and you go through everything with them. “They share everything with us,” she said. “A lot of these patients originally didn’t want to be independent,” says Nicky.

The centre sees 110 patients at the moment up from 85 when they opened nearly two years ago.

When renal patients are in the in-centre unit, there is a 1:3 nursing ratio. Under the Assisted Care Programme it is a 1:5 nurse ratio. “This has allowed us to grow in patient numbers without increasing nursing staff. It also facilitates independence for patient care,” she says.

They have trained 22 patients the past year. Kidney failure is a growing problem in New Zealand with well over 2300 people now using dialysis.

Around 80-100 new patients in the Midland region, which includes Waikato, Lakes, Bay of Plenty, Tairawhiti district health boards, are expected to start dialysis in the next year.

The demand for dialysis services in New Zealand is predicted to grow at around 4-5 per cent each year over the next 10 years.

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